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Schreiner et al. Plast Aesthet Res 2018;5:32 I http://dx.doi.org/10.20517/2347-9264.2018.45 Page 5 of 6

lateral pectoralis major muscle has therefore been preferred in our patients. The chest wall reconstruction
using the pectoral PMF enabling successful long-term infection control within the SCJ has already been de-
scribed [6,15,16] . In addition to the described technique, other clinically important issues have to be taken into
consideration. Firstly, the higher perioperative risk associated with the liver impairment has to be expected.
Therefore, staged procedure adapted to the reduced patient status is recommended. Secondly, a wide involve-
ment of the neighbouring structures and mediastinum was present in all our cases. Finally, the aggressive
one stage approach with the SCJ resection and simultaneous muscle transposition is associated with higher
complication rate and can be replaced by the presented staged strategy.

In conclusion, the staged NPT based surgical therapy of the acute SCJ infections in patients with hepatic
impairment is feasible. It helps reduce the high perioperative morbidity, maintaining the principles of wound
management. The presence of liver dysfunction and consequent coagulopathy is associated with increased
blood product demand and requires a well-balanced interdisciplinary approach.

DECLARATIONS
Authors’ contributions
Study design: Schreiner W, Horch RE, Sirbu H
Sequence alignment and manuscript drafting: Schreiner W, Dudek W, Trufa DI
Statistical analysis: Schreiner W
Coordination of the study: Horch RE, Sirbu H
Read and approved the final manuscript: all authors

Availability of data and materials
Results are reported in the manuscript, patient´s individual data are not available to the public for the sake of
data protection laws.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
There are no ethical concerns over the study.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

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